PB2101: TREATMENT OF AGGRESSIVE B-CELL LYMPHOMA WITH DA-EPOCH-R, A SINGLE CENTRE EXPERIENCE
Authors: E.-K. Dimitraki, C. Giatra, M. Delatola, A. Roumelioti, L. Ligdi, P. Kosmas, V. Drakopoulou, E. Souravla, I. Darmani, G. Kanelis, L. Marinos, K. Sakellariou, D. Karakasis, M. Bakiri, M. Bouzani
Journal: HemaSphere (2022)

Background: Dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab (DA-EPOCH-R) is a 96-hour continuously infused regimen, aiming to improve first-line treatment of aggressive B-cell lymphoma. Prolonged exposure to chemotherapeutic drugs and dose intensification target to reduce tumor resistance, however toxicity remains a barrier for the broad use of this regimen. Aims: To reveal the experience of our Centre on the treatment of aggressive B-cell lymphoma with DA-EPOCH-R Methods: We retrospectively collected data from 54 consecutive patients treated with DA-EPOCH-R in our Department. Results: Thirty one women and 23 men with median age of 37 years (range 18-76) were diagnosed between 2013 and 2021, with a High Grade B-cell Lymphoma, HGBCL (24 cases) and Primary Mediastinal B cell Lymphoma, PMBCL (30 cases). The Ann Arbor stage was I (16 cases), II (14 cases), III (5 cases) and IV (19 cases). The majority (85%) of patients had good (0-1) ECOG performance status. All but 2 patients were HIV positive. All patients were planed to be treated with 6 cycles of DA-EPOCH-R. Ten patients changed treatment plan due to disease progression (5 patients) and toxicity (5 patients). Among patients with HGBCL, 19 achieved a complete response (CR), 3 manifested resistant disease (RD) and for 3 patients response assessment was not possible due to disease related early death. Among patients with PMBCL, 24 showed CR, 1 patient partial response and 4 patients a RD. With a median follow up of 23 months (range 1- 86), the median progression free survival (PFS) and overall survival (OS) of all patients were not reached. Comparing survival between HGBCL and PMBCL, the latter had significantly better PFS and OS. Among the 42 patients who completed 6 cycles of treatment, only 3 reached the level 5 of dose escalation, 12 the level 4, 13 the level 3, 7 the level 2 and 4 remained at the level 1. Seven cases underwent 1 step of dose increase, 14 patients 2 steps 13 patients 3 levels and 3 patients 4 levels. The administration of high dose methotrexate in 11 patients, hampered the dose escalation. In 7 subjects, level deescalation was required (1 level for 6 patients and 2 levels for 1patient). Toxicity was manifested in 51 out of 54 patients. Haematological toxicity with neutropenia was the most common side effect: grade 4 in 88%, grade 3 in 7%, grade 1 in 5%. Severe thrombocytopenia was manifested in 7 cases. All patients received erythropoietin to treat anaemia. Thirty five subjects (65%) suffered from febrile neutropenia. Fever was related to bacterial infection in 14 cases (37%) and viral infection in 7 cases (20%). Neuropathy was observed in 11% of patients, stomatitis in 24%, gastrointestinal side effects in 13% and grade 3 or greater hepatic toxicity in 11%. Eight patients died, all due to disease relapse or progression. No death was attributed to treatment toxicity. Summary/Conclusion: DA-EPOCH-R is an effective treatment for aggressive B-cell lymphoma limited by tolerability. Its administration should be confined to subgroups where the efficacy of this regimen is clearly superior.